Objective:To investigate the therapeutic effect of surgical clipping ruptured posterior communicating artery aneurysms (PCoAA) originating from fetal-type posterior cerebral artery (FPCA) via lateral supraorbital approach and the influencing factors of the outcomes.Methods:Patients with ruptured PCoAA originating from FPCA underwent surgical clipping via lateral supraorbital approach in the Cerebrovascular Center of Foshan Hospital of Traditional Chinese Medicine from January 2017 to May 2020 were retrospectively enrolled. The Glasgow Outcome Scale was used to evaluate the outcomes of patients at 6 months after operation. 4-5 points were defined as good outcome, and 1-3 points were defined as poor outcome. Multivariable logistic regression analysis was used to determine the risk factors for poor outcomes. Results:A total of 119 patients were enrolled, including 98 females (82.35%), aged 61.59±11.52 years old (range 32-78 years). Thirty patients (25.21%) had poor outcomes. Multivariable logistic regression analysis showed that age (odds ratio [ OR] 2.935, 95% confidence interval [ CI] 2.117-5.391; P=0.012), hypertension ( OR 2.016, 95% CI 1.568-4.335; P=0.023), Hunt-Hess grade ( OR 2.408, 95% CI 1.326-5.068; P<0.001), modified Fisher grade ( OR 3.034, 95% CI 2.201-5.517; P<0.001), aneurysm size ( OR 1.793, 95% CI 1.427-2.622; P=0.009), preoperative intracranial hematoma volume ( OR 1.246, 95% CI 1.055-2.153; P=0.011) and surgical timing ( OR 2.152, 95% CI 1.316-3.240; P=0.006) were the independent risk factors for poor outcomes of the patients. Conclusions:Surgical clipping via lateral supraorbital approach can effectively treat the ruptured PcoAA with FPCA. Patients with age >65 years, with a history of hypertension, high Hunt-Hess grade, high modified Fisher grade, aneurysms >7.65 mm, preoperative intracranial hematoma volume >19.02 ml, and late surgery need to strengthen postoperative management to improve outcomes.